1) Quote of the Week
2) The Art of Midwifery
3) News Flashes
4) A Sampling of International Articles and Letters
5) Check It Out!
6) Question of the Week
7) For Coming E-News Themes
8) Question of the Week Responses
9) What Are You Doing for International Midwives' Day?
10) Switchboard
11) Classified Advertising

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1) Quote of the Week:

"Through partnership, within a respectful relationship and within a two-way exchange of ideas and knowledge, we can weave together both traditional midwifery and the appropriate use of evidence-based practice within a midwifery model: midwives, working together to strengthen each other and make birth safe and sacred for women worldwide."

- Jenna Houston

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2) The Art of Midwifery

Midwives, remember these things about babies: guard and protect them in the
birth process; talk to those babies as you care for them, as you help them to
the breast, while you do their baby exams. I am constantly noting the level of their response, even during little things like when I look a baby in the eye and
say, "What a fine looking baby." I invariably see a proud and happy look appear
on the baby's face. Advocates of gentle birth have criticized painful birth practices,
including injections and heel lancing in the neonatal period. We cannot always
avoid these things. However, when I approach the baby, I always look at him or
her first and say, "I'm sorry honey, I have to stick your heel"-a gesture, at
least, to the intelligent newborn. It is truly said that midwives hold the future.

When Finland's number of small maternity units dropped from 132 in 1964 to 45
in 1995, the accidental birth rate rose. Rates were more common when women already
had three or more children. Babies were likely to be smaller and preterm. The
crude perinatal mortality rate was 37.9 per 1,000 compared with 6.4 for hospital
births; adjusted for risk factors (prematurity and small babies), the rate was
20 per 1,000 when adjusted by birthweight and 18 per 1,000 adjusted by length
of gestation. Researchers concluded that when a birth care system in a sparsely
populated area is centralized, causing greatly increased traveling time, the higher
risk of accidental out of hospital births needs to be considered.

- AIMS Journal, Spring 2000

o=o=o=o=o=o

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A distressing cross-cultural trend is showing up in the growing body of
anthropological literature about midwifery and birth in the developing
world. From Tanzania to Papua New Guinea, anthropologists who observe professional
midwives giving prenatal care and attending births increasingly note that, far
from the midwifery ideal, professional midwives often treat women very badly during
birth, ignoring their needs and requests, talking to them disrespectfully, ordering
them around, and sometimes even yelling at them and slapping them. At the same time, and in direct
correlation, the professional midwives are themselves often treated badly by the
healthcare systems in which they work. They are almost always underpaid, are frequently
mistreated by physicians who rank above them in the medical hierarchy, and generally
work long hours under stressful conditions that often include inadequate facilities
and equipment and too many women with too few midwives to care for them well.
In short, professional midwives are often trapped in the biomedical healthcare
system, a system that is failing to meet the needs of birthing women in developing
countries....

Not surprisingly, even though the governments of these countries have
embarked on massive programs to bring birth into the clinics and hospitals, many
rural women resist, choosing instead to birth at home with a community midwife.
Officially labeled "traditional birth attendants" (TBAs) by WHO and UNICEF because
they do not meet the international definition of a midwife, these community midwives
are usually older women who have given birth several times and who have become
midwives by being asked to attend the births of friends and relatives, slowly
gaining first-hand experience of birth. Some of them undertake long apprenticeships
with experienced community midwives, while others learn simply by attending births.
From the point of view of villagers and townsfolk all over the developing world,
the biggest difference between community and professional midwives is that community
midwives are recognized by their community as midwives, while the professionals
are often seen as young and inexperienced women who have to prove their worth
to the villagers before they can be trusted.

To read in its entirety this compelling article, written by an anthropologist whose specialty is midwifery and birth practices, go to:

Traveling to other communities, especially those in other countries, is a great way to break routine and get a new perspective on life and midwifery. Observing different forms of midwifery care can inspire one's own practice. I will never forget the first time I saw a cesarean section in a hospital in China. A single acupuncture needle supplied the only anesthesia to the wide awake woman, who chatted with the doctors while they opened her up. The point was not for me to run home and do surgery this way but to realize that the way we do surgery is only one way to do it. When I was in England and learned about their Good Birth Guide in which hospitals and their birthing options--including choices for visitors, birthing positions, anesthesia, and so on--are listed by name and rated from no star to four stars, I learned a new idea about effective political strategy to improve birthing practices.

- Marsden Wagner, Midwifery Today Issue 41

====

From The Bahamas

We are all excited here about celebrating International Midwives' Day. We have
involved the director of nursing and administrators at both our major hospitals
in supporting midwives and mothers at this time.

We plan to participate in a health walk on May 6, we held a press
conference on May 3 and are wearing buttons to work on Midwives' Day. We will
also man a booth at a shopping mall to show that midwives are not old women but
young, vibrant, intelligent women!

We are already planning next year's celebration, which will include a luncheon or banquet to honour pioneering midwives in the country and outstanding practising midwives.

- Maxine Brown

====

From a Hospital Somewhere in Europe: A Sad Lesson

I have a colleague who is a brutal midwife. She does not hesitate to use a drip
of syntocinon full speed so the woman gives birth very fast (2 or 3
hours). Sometimes(far too often)the baby shows signs of suffering. She then dilates
the cervix forcefully with fingers, and calls the obstetrician for a forceps.
(If a woman wishes an epidural-free birth she acts the same way, a bit less brutal
maybe but hardly. Maybe the baby has less cause for suffering, but the mother,
more).

This time she welcomes a woman for her third birth. It is around 8 p.m., so
I believe she speeds up the labour as she does usually. The baby starts to show
slight discomfort. The dilatation is 8 cm. She calls the registrar for help. The
registrar tries forceps to no avail (too much difficulty with the cervix and a
preceding case of injured baby). So she stops, and they decide on a cesarean.
They have no special worry and do not listen anymore to the trace. When the baby
is born, it is not alive anymore.

It is a very sad story for mother and baby but it is a strong sign that
such brutal behaviour with women and babies is wrong. I hope she can hear this
warning (is it the proper word? As she had already warnings before with babies
escaping dips and bradycardia. But did she care? She thought she proved right
most of the time.)

- Anon.

=====

From Israel

In my normal, day to day life, with family, friends, co-workers and
neighbors, I am a pleasant, easy to get along with person with a balanced personality,
not subject to mood swings, with a rather optimistic view of life. As a midwife
taking care of women, I am understanding, enthusiastic, and supportive.

As a midwife trying to bring about changes in so many ways, I myself
change--into a schizophrenic, mania/depressive personality!

There I am one day, setting the date for our first meeting with the
doctors of the ward, to talk about the change of concept needed if we are to enable
our women to deliver their babies without drugs and intervention. I type up pages
full of midwifery philosophy and birth plans, read paragraphs over the telephone
to another midwife, ask which doctors should be invited and who I should send
all these papers to. The next day, with my adrenaline high, I give the papers
to our head doctor, who had originally approved of the idea. Two hours later he
comes back to me, angry: Who was I to take it upon myself to write these papers,
and to suggest who they should be sent to?! Oh, and did we decide on a date for
this meeting? He didn't remember such a thing.

BANG! All the air is out of my balloon. Was I crazy to think that change
was really possible? That's it--it is only a huge illusion that any real
change will be made in our ward. Oh yes, perhaps the doctors will OK the idea
to spend some money on a decorative lamp or bed cover, and a little sign near
an enlarged room saying "Room for Natural Childbirth," or maybe even a bath!--but
will any real effort be made to change anything in our policies toward making
childbirth a more normal physiological happening rather than a potential for an
any-time-now catastrophe?

For two days I contemplate leaving--maybe forever!--my loving family, my community,
my friends and going off to any part of the world so I can *just be a midwife!*
For two days I just do my work, expecting nothing but complicated births, and
surprisingly the women I am with have beautiful, uncomplicated births and are
so appreciative of my way of helping them! So in spite of myself, my spirits rise.
And when another midwife asks me to quickly put in an IV line and add some Pitocin
to a birthing mother who is rather stuck in her second stage, I quietly suggest
that we try the "towel method" (the mother pulling the towel while pushing the
baby out) that I learned from the Alaska List. Two pushes later, the baby is out.
This usually ungracious midwife compliments me on the "new method" and I am happy
again! When I think about all the changes that have taken place at our ward in
the past three years, I *know* that change *is* possible! But then a thought goes
through my mind again: this is only a drop in the sea!

So am I schizophrenic, or what?

- Leslie

====

From New York

Doulas honor and celebrate the work of the midwife.

On International Midwives Day, the Metropolitan Doula Group, in cooperation
with the Elizabeth Seton Childbearing Center, is hosting its second annual celebration
of midwives in New York City. Five hundred midwives and birth professionals have
been invited to share an afternoon of massage, refreshment and entertainment.
The members of the doula group will massage any midwife (or reporter) who attends,
in an effort to demonstrate a tangible part of the work that they do during labor.

The Metropolitan Doula Group is a support group for aspiring and
experienced doulas. This year the members of the group have provided labor support
to over 150 women. In a growing effort to reach out to the
communities, they have provided volunteer doulas to pregnant women who would otherwise
give their babies up for adoption. Volunteers also work with women in need at
Brookdale Hospital and at the Elizabeth Seton Childbearing Center. The group is
an active participant with Maternity Center Association in the Mother/Baby Health
Project for homeless women in two shelters in Brooklyn.

The greatest challenge for both doulas and midwives is working with
families, care providers and institutions that fear birth. Since midwives
do not have privileges at many hospitals, doulas, who are accepted into
every hospital in the NY area, can offer their continuous calming presence during
labor to families who want something more than routine obstetrical care. Doulas
hope to give these families, and the institutions they give birth in, a small
taste of the value of the midwifery model of care.

====

From Montreal, Quebec, Canada

Since September 1999, midwifery is legal in Quebec Province, Canada. Before,
we had "no legal status" for midwives, and families in Quebec worried about the
risk of legal prosecution. We wanted midwives to be able to practice where women
give birth [in the home, if desired].

Today we have birth centers. At first there were the "projets-pilotes" to
evaluate how midwives practice (eight years). Law 28 (my worst nightmare) has
delayed approval of homebirth until the government passes homebirth practices
rules. Our government (social-democratic) didn't want to have to also pay midwives
in case of transfers, so midwives stopped going with women in case of complications.
We have a public health system here; it means society now pays for midwifery care,
and this means regulations, norms, protocols, etc.

The situation is hard here because women give birth alone, or in the
hospital, and I'm afraid we have lost our midwifery soul. If a midwife goes to
the home she can be fined between CAN$600-$6,000, and if a friend and/or husband
performs midwives' protected acts (like catching the baby) they can be fined too,
for each act-illegal midwives' act and illegal birth place. What is for our future,
for our children's future?

- Marypascal

====

International Credentialing of Midwives

The world has become a global village. With this freedom to share
information comes the ability to travel and relocate. When midwives move from
one country to another, they should, with equivalent education and credentials,
be able to practice their profession wherever they live. However, cultures, languages,
customs, values and attitudes can cause midwifery practices to vary from one country
to another. Prerequisites and the curricula of midwifery education, as well as
the credentialing process, may differ from place to place.

An interactive educational software package focusing on pregnancy and childbirth
which takes a woman through pregnancy week-by-week. Written by a doctor and a
midwife. Includes a fun bonus screen saver that helps in choosing the baby's name.
www.infantime.com

=THANK YOU!=

5) Check It Out!

~~~WWW.MIDWIFERYTODAY.COM~~~
A Web Site Update for E-News Readers

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Midwifery Today International Exchange Network Directory is helping build
a worldwide community of birth practitioners who can learn from each other, visit
each other's homes and practices, and form lasting friendships. To learn more
about it and how to be included, go to:
www.midwiferytoday.com/mt/international/ntdirectory95.html

~~~~~~

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6) Question of the Week

Q (repeated): I am wondering about the safety of homebirth with the
presence of fibroid tumors. Can someone with experience in this area help me with
the risks and things to watch for?

- Bea Tarr

====

Q: I have a client who is expecting her third baby. She planned a homebirth
with her first baby, but transferred to a hospital after her cervix became very
edematous. During her second labor (planned hospital birth), she again developed
a very edematous cervix in active labor. She had a CNM as a birth attendant, and
many things were tried, including water therapy, hands & knees, ice to the
cervix, other position changes. She eventually requested and received an epidural
at 9 cm, due to exhaustion, and delivered with vacuum assistance. Does anyone
have any ideas, such as herbal treatments during pregnancy, other options during
labor, hopefully to prevent the edema, or at least to more effectively reduce
it? Has anyone used arnica during labor, either sublingually or directly to the
cervix? Is that safe? This very lovely lady is only about 20 weeks, so has some
time to prepare.

2. Labor & Delivery Nurses: Here is your chance to speak up! How can
midwives and doulas be more responsive to your needs? How can you work more effectively
together? Are there any concerns you'd like to air in E-News?
Tell us about them!

3. Aromatherapists: What are some of your favorite aromatherapies for
pregnancy, labor, birth and postpartum?

**Please take part in E-News! Sound Off-Give Advice-Share Your Knowledge!**

Editor's note: Responses to last week's question about anterior lip will be
held over to a coming issue. Stay tuned!

o=o=o=o=o=o

9) WHAT ARE YOU DOING FOR INTERNATIONAL MIDWIVES DAY?

*Send your local midwife a card of thanks!
*Take her out to lunch!
*Write a letter of thanks to the editor of your local newspaper!
*Volunteer at her clinic!
*Distribute her flyers and brochures!
*Talk to anyone who will listen about midwifery and homebirth!
*Host a birth stories evening!
*Hold a video showing!
*Write a newspaper article discussing midwifery and homebirth!
*Promote midwifery in your local hospitals, birth centres, community health centres,
public health centres, single mothers' homes, and anywhere else you can think of!

*Lobby on her behalf! Contact your local association of midwives for
information about key issues.
*Co-sponsor a midwifery/birth conference!

Our midwives are our protectors. If we want them to continue providing
care, we need to demonstrate our love and care of them, and promote their role
in women's health. Do all you can!

- Midwifery Consumer Advisory Board (MCAB)

o=o=o=o=o=o

Midwifery Today Issue 53 (current issue) is all about INTERNATIONAL
MIDWIFERY, and is a fascinating read! Special price to E-News readers: $11.50
plus shipping & handling when you mention Code 940 (Regular price is $12.50).
To order back issues, call 1-800-743-0974 (orders only, please).

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Know a strong woman? Helping empower one? If you haven't already done so, please
forward this issue of Midwifery Today E-News to one or two of your friends or
business associates. Thanks so much!

o=o=o=o=o=o

10) Switchboard

Many readers responded to a letter in last week's issue regarding
diaphragmatic release as a way to resolve persistent posterior. Following is midwife
Judy Jones's explanation of how to do it:

It is easy to recognize a persistent posterior baby. You cannot feel the
back on palpation, rather only little lumps and bumps of limbs. To do a
diaphragmatic release, it is best to have the mother lie on her back. If
she is in advanced pregnancy and this makes her very uncomfortable, you can have
her lie in a recliner or semi-sitting position. If you use that
position, place a small pillow or adequate support behind her lower back.

One hand will go horizontally across her lower back where the uterine
ligaments attach. This is where you would put lower back pressure during labor.
You do not need to press, as just the pressure of the mother lying on your hand
will be sufficient. (Be sure you take off any rings you may be wearing, for your
hand's sake!)

The top hand will go on top of the abdomen, horizontally just above the
pubic bone with the thumb upward. Just rest it lightly on the abdomen, no pressure.
Then all you have to do is wait. Things may start right away or it may take several
minutes before you feel anything. What you will feel is a motion beneath your
hands. For the hand in back it will feel much like it does when there is a contraction
taking place during labor as you feel the muscles tighten and contract beneath
your hand and release. For the top hand it will be either a waving motion or a
circular motion under your hand. At first you will think you are just imagining
it, but you are not. The best description I can give is that it feels as if the
mother has a tennis ball in her abdomen that is being bounced back and forth between
your hands. As it hits one hand it will roll across it or around underneath it
and then bounce back to the other hand. Sometimes the motion is so great that
it will actually make your hand wave on the abdomen. Sometimes the mother will
feel things inside, sometimes not. What she feels may not be located where your
hand is located. The movement under your top hand may stay all in one place or
move around. If it moves, try to gently follow it with your top hand to keep it
centrally located under your hand. Do not move the back hand. Sometimes it will
move around in a circle, sometimes off to one side, or even clear down to a hip.
It all depends on the muscles that are involved and the type of injury that precipitated
all the spasm of abdominal muscles. Our muscles really only know how to contract
and shorten, not how to relax and lengthen. They depend on another counter muscle
to contract and pull the first one out of contraction. Abdominal muscles do not
have as many counter muscles, so this technique allows the muscles to relax.

If you go back into the mother's history, you will almost always find a
history of a car accident (especially with a seat belt on, where there has
been a twisting of the abdominal muscles because we use only one-shoulder restraints)
or severe fall. However, I have had a mother cause it simply by doing too much
hoeing in the garden.

You continue the diaphragmatic release as long as you feel motion under your
hand. Usually it will just fade away and you will no longer feel it. Sometimes,
if you end up over a bony prominence, it will end with a
vibration. The process takes some time, often at least 20-45 minutes. But if you
consider the time you save in labor, it is well worth it. You may
need to repeat the process over several visits. I usually start at about
the 6th month unless I have a mother with a history of car accident or
several prior posterior babies. This procedure has also been used this
technique to turn breech babies. I use it for transverse but find it less
effective for breech. I usually use a tilt board for breech and then do a
diaphragmatic release after the baby turns. It works marvelously well for
posteriors. I have never done one where the baby did not turn to anterior.
However, on some occasions, after a few days the baby will turn back to
posterior and you will need to repeat the process more than once. The more severe
the history, the more likely you will need to do it several times before the baby
will stay anterior.

Posterior babies use to be the worst problem I had in births. The long hard
back labors wore us all out and occasionally ended in transfers for
maternal exhaustion. I am thrilled not to have these any more. Now my
biggest problem is cervical lips! But I am working on a solution for that
also, using evening primrose oil!

I do believe every midwife should have this valuable tool, the
diaphragmatic release, in her bag of tricks. It is so easy and
non-interventive. It is much better than other suggestions I have seen of
putting your fingers in the baby's suture lines and trying to turn the head!

- -Judy Jones

====

Some weeks ago Nikki Lee wrote in that "according to the medical literature
human gestation ranges from 36-44 weeks." Here in Colorado we are required by
law to send any woman who goes longer than 42 weeks to a doctor. We are no longer
able to be her midwife. Legislation may be changed on May 15 and I would like
to be able to support the SAFETY of going longer. Can someone help me with documentation
of this so what I say might be more effective?

Midwives know that the 280 day pregnancy is merely an average, but "what we know"
doesn't seem to hold water with law makers! I'd appreciate any documentation I
can get from medical literature. I do not have access to the Internet except at
the public library, where time is very limited.
Elaine
Reply to: auntie-freeze@Juno.com

====

We need your help!!
Please email webgilr@midwiferytoday.com with names of celebrities or major, minor
or local "names" who have had a homebirth or used a midwife or doula. We need
info--news clippings or information regarding this matter--ASAP!
Reply to: WebGirl@midwiferytoday.com

====

I am expecting my first baby and although I won't be giving birth for 7
more months, I'm already nervous about the experience. I have a low
tolerance for pain so I would like to give birth in a hospital because I am
considering an epidural. I would rather not have to lie on my back with my feet
in stirrups while giving birth. Do hospitals allow the mother to use different
positions such as squatting and sitting? Any information you can give me would
be greatly appreciated.

- Anon.

====

I am an RN on maternity leave. While I love just being a homemaker, I
figured I could also use the time to enhance my career. I want to become a certified
childbirth educator and a doula. I figure I'll get certified in lactation consulting
in a few years since it takes so long. I can't decide which of the first two would
be best to do now. Any suggestions?

- Anon.

====

This is a follow up to my question about miscarriage posted in last week's issue:

The other sonogram and subsequent blood work ruled out another miscarriage but
we are all a little baffled. The first sono revealed a 4 wk sac and fetal pole
(but my calendar showed 7 wks), the second sono exactly one week later revealed
a healthy 8 wk fetus and a yolk sac, and my HcG level was consistent with an 8
wk. pregnancy. Can anyone explain this? Have you seen it before? Is this "normal"?
Even my practitioner is a little stumped. I'm just happy that it wasn't a miscarriage!

- L.S.

====

I am 14 weeks pregnant. I had breast reduction surgery 15 years ago and also
have inverted nipples (not as a result of the surgery). Is there
anything I can do to increase the chances that I'll be able to breastfeed?
Does anyone know the stats on the percentage of mothers who can breastfeed following
breast reduction?

- Liza

====

I am breastfeeding my one year old. I go to classes two nights a week and her
father gives her bottles of my expressed milk. Later this month I am attending
a doula conference and will be away from her all day for three days. My freezer
is inadequate and frozen milk usually ends up tasting bad, therefore I express
it fresh for her. I am considering using goat milk on the days I will not be available
for her. I will also try to express as much milk as possible. Has anyone had any
experience with feeding babies goat milk? I gave her a small amount to try and
she seems to tolerate it well.

- M.C.
Reply to: melaniecurrier@hotmail.com

Editor's note: Midwifery Today does not advocate the use of breastmilk substitutes of any kind except under the most serious circumstances.

Unless otherwise noted, share your responses to Switchboard letters with E-News readers! Send them to mtensubmit@midwiferytoday.com. If an e-mail address is included with the letter, feel free to respond directly.

Need your article, thesis, essay or book edited and/or proofread? I have worked with pregnancy, birth and midwifery related manuscripts for thirteen and a half years and know the field well. Sliding scale.cherjm@aol.com

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